Purpose: Patients with advanced biliary tract cancer (BTC) have a poor survival. We aim to evaluate the efficacy and safety of nab-paclitaxel plus gemcitabine and cisplatin regimen in Chinese advanced BTC patients. Materials and Methods: Eligible patients with locally advanced or metastatic BTC administrated intravenous 100 mg/m2 nab-paclitaxel, 800 mg/m2 gemcitabine, and 25 mg/m2 cisplatin every 3 weeks. The primary endpoint was progression-free survival (PFS). The secondary endpoints included overall survival (OS) and adverse events, while exploratory endpoint was the association of biomarkers with efficacy. Results: After the median follow-up of 25.0 months, the median PFS and OS of 34 enrolled patients were 7.1 months (95% confidence interval [CI], 5.4 to 13.7) and 16.4 months (95% CI, 10.9 to 23.6), respectively. The most common treatment-related adverse events at ≥ 3 grade were neutropenia (26.5%) and leukopenia (26.5%). Survival analyses demonstrated that carcinoembryonic antigen (CEA) levels could monitor patients’ survival outcomes. A significant increase in the number of infiltrating CD4+ cells (p=0.008) and a decrease in programmed death-1–positive (PD-1+) cells (p=0.032) were observed in the response patients. Conclusion In advanced BTC patients, nab-paclitaxel plus gemcitabine and cisplatin regimen showed therapeutic potential. Potential prognostic factors of CEA levels, number of CD4+ cells and PD-1+ cells may help us maximize the efficacy benefit.

Objective To understand the regional epidemiology and antibiotic resistance pattern of diarrheagenic E .coli infection in children ,and to clarify the pathogenic association between diarrheagenic E .coli infection and childhood diarrhea .Methods Totally 680 diarrheal children in the outpatient setting and 680 non-diarrheal control children were enrolled prospectively .The stool samples were collected and the potential enteric pathogens were detected .Minimal inhibitory concentration (MIC) method was used to determine the antimicrobial susceptibility for diarrheagenic E .coli isolates .Results The isolation rates of diarrheagenic E .coli in diarrhea group and control group were 15 .6％ and 13 .1％ ,respecitvely ,and diarrheagenic E .coli was the most commonly detected enteric bacteria .Multivariate logistic regression analysis adjusted for age suggested no clinical association between diarrhea and infection with enteropathogenic E .coli (EPEC) (aOR=1 .2 ,95％ CI:0 .8-1 .8) ,enteroadhesive E .coli (EAEC) (aOR=1 .1 ,95％ CI:0 .7 -1 .6) and enterotoxigenic E .coli (ETEC) (aOR= 1 .8 ,95％ CI:0 .5 -6 .2) . Among 199 diarrheagenic E .coli strains ,the rates of resistance to ampicillin ,tetracycline ,trimethoprim-sulfamethoxazole ,azithromycin ,and ceftriaxone were 63 .8％ ,55 .8％ ,48 .2％ ,34 .2％ and 26 .6％ , respectively ,while the rates of resistance to ciprofloxacin , amoxicillin-clavulanate and cefoxitin were 4 .5％ ,1 .5％ and 0 .5％ ,respectively .Conclusions Diarrheagenic E .coli is the most common enteric bacteria detected in the stool samples from children with and without diarrhea in this study . The pathogenic role of infections with EPEC ,EAEC and ETEC in childhood diarrhea is not determined .EHEC and EIEC are rarely detected and further studies are needed to clarify the pathogenic association between infection with EHEC ,EIEC and childhood diarrhea .

Objective To observe the effect of 3D-Slicer combined with sina software assisted minimally invasive neuroendoscopic surgery for hypertensive intracerebral hemorrhage,and investigate the application value of 3D-Slicer combined with sina software in the preoperative localization of minimally invasive neuroendoscopic surgery.Methods From July 2015 to October 2017,38 consecutive patients with supratentorial hypertensive intracerebral hemorrhage admitted to Shunde Hospital,Guangzhou University of Chinese Medicine were enrolled retrospectively.According to the different treatment methods,they were divided into an endoscopic group and a puncture group (n =19 in each group).The endoscopic group was treated with 3D-Slicer combined with sina software for neuroendoscopic hematoma removal,and the puncture group was treated with the hematoma minimally invasive soft-channel puncture and drainage under the CT localization.The effect of 3D-Slicer combined with sina software in the preoperative localization of hypertensive intracerebral hemorrhage by the minimally invasive surgery was evaluated by comparing the hematoma clearance of the first and third day of the two groups of patients after procedure,puncture to the preset position success,postoperative rebleeding,postoperative complications,and good prognosis at 3 months after procedure.Results The clearance rate of hematoma at the first day after operation in the endoscopic group was significantly higher than that in the puncture group ([90 ± 10]％ vs.[46 ± 16]％;t =2.348,P ＜ 0.05).The success of the puncture to the preset position was better than that in the puncture group (19/19 vs.14/19;x2 =5.758,P =0.016),and postoperative rebleeding rate was lower than that in the puncture group (0 vs.4/19;x2 =4.471,P =0.034).There were significant differences.There was no significant difference in postoperative infection complications between the two groups (all P ＞ 0.05).The prognosis of the endoscopic group was good in 17 patients within 3 months after procedure,and the prognosis was good in 11 patients in the puncture group.The good prognosis in the endoscopic group was better than that in the puncture group (x2 =4.866,P =0.027).Conclusion The effect of 3D-Slicer combined with sina software assisted minimally invasive neuroendoscopic surgery for hypertensive intracerebral hemorrhage was better than the hematoma minimally invasive soft-channel puncture and drainage under the CT localization,and the 3D-slicer combined with sina software can provide rapid and accurate preoperative localization for minimally invasive neuroendoscopic surgery of hypertensive intracerebral hemorrhage.

Objective To monitor the clinical epidemiology and etiology of acute diarrhea in children in the outpatient setting in Shanghai .Methods An active surveillance study in Children′s Hospital of Fudan University between August 2013 and July 2014 was conducted .Outpatient children with acute diarrhea were enrolled in this study and stool samples were collected .Pathogens including norovirus ,diarrheagenic Escherichia coli (DEC) , nontyphoidal Salmonella spp .(NTS),Campylobacter,Shigella,pathogenic vibrio and Yersinia enterocolitica were identified and typed .The χ2 test was used for statistical analysis .Results Of the 881 stool samples from enrolled children , the pathogens included into the target detection were identified in 246 (27 .92% ) cases . Norovirus ,DEC ,NTS ,Campylobacter and Shigella were detected in 98 (11 .12% ) cases ,74 (8 .40% ) cases , 61 (6 .92% ) cases ,34 (3 .86% ) cases and 2 (0 .23% ) cases ,respectively .Neither pathogenic vibrio nor Yersinia enterocolitica was identified .Children younger than 36 months old (3 .27% ,26/794) had a lower risk (χ2=7 .41 ,P=0 .006) of Campylobacter infection compared with older children (9 .20% ,8/87) .Vomiting (37 .76% ) and watery diarrhea (21 .34% ) were more commonly seen in children with norovirus infection;fever and mucous stool were commonly seen in diarrheal children with NTS infection (40 .98% and 21 .31% ,respectively) and Campylobacter infection (29 .41% and 26 .47% ,respectively) .Conclusion Enteric pathogens play a major role in childhood acute diarrhea in Shanghai .Continuous monitoring of enteric pathogens will be helpful for reasonable treatment and prevention of acute diarrhea in children .

Objective To understand the clinical epidemiology and manifestation of nontyphoidal Salmonella (NTS)enteric infections and serotypes and antibiotic resistance patterns of NTS in children.Method All cases with probable acute bacterial inflammatory diarrhea were included into this study from the Children's Hospital of Fudan University during January 2012 through December 2014.Salmonella species and other major enteric bacteria were routinely isolated from the fresh stool sample of the enrolled patients at their first visit to the enteric clinic.Salmonella isolates were serotyped and tested for antimicrobial susceptibility testing using Kirby-Bauer method at the reference laboratory of Shanghai Municipal Center for Disease Control and Prevention.All enrolled cases had clinical records.The enumeration data were described by constituent ratio.Result Of the enrolled 3 143 patients,742 (23.6％) were confirmed to have Salmonella infections,and NTS was identified in 738 (23.5％) cases and Salmonella Paratyphi B was identified in 4 (0.1％) cases,respectively.The isolation rate of NTS exceeded diarrheagenic Escherichia coli (6.7％,182/2 727),Campylobacter (4.1％,129/3 143) and Shigella (2.4％,77/3 143).Nine serogroups and 41 serovars were identified in 742 salmonella isolates.Salmonella Enteritidis and Salmonella Typhimurium were the most common serovars,representing 42.6％ (316/742) and 28.2％ (209/742) of isolates,respectively.NTS infections were prevalent year-round with a seasonal peak from May to October.The common symptoms included tever (57.5％,424/738) and blood-in-stool (31.0％,229/738).Antimicrobial susceptibility showed only 8 (1.1％) of 742 isolates sensitive to 16 tested antibiotics.Resistance to the current first-line antibiotics such as the third-generation and (or) fourth-generation cephalosporins (cefotaxime and cefepime),ciprofloxacin was detected in 10.0％ (74/738),8.1％ (60/738) and 1.1％ (8/738),respectively.Conclusion NTS is the leading causative agent responsible for bacterial inflammatory diarrhea in Shanghainese children.The prevalence of NTS enteric infections show an increasing trend year by year.It is essential to continuously monitor the antimicrobial resistance of NTS and trace the source of infection to prevent and treat NTS infections in Shanghai.

Objective To investigate the pathotypes,epidemiological characteristics and antimicrobial resistance of diarrheagenic Escherichia coli (DEC) in children with acute bacterial diarrhea in Shanghai.Methods A total of 2 071 outpatient children with probable acute bacterial diarrhea referred to the enteric clinic of Children's Hospital of Fudan University during June 2012 to June 2014 were enrolled in our study.The stool samples were processed for routine microbiologic and biochemistry tests to identify enteric bacteria,including enteropathogenic Escherichia coli (EPEC),enterotoxigenic Escherichia coli (ETEC),enteroinvasive Escherichia coli (EIEC) and enterohemorrhagic Escherichia coli (EHEC).Kirby-Bauer method was used to identify the antibiotic sensitivity.Difference of means between groups was compared by chi-square test.Results Of 2 071 enrolled children,DEC were identified in 145 (7.0 ％)cases.148 strains were isolated with three of mix infection strains.All DEC isolates in this study included 106 (71.6％) EPEC,24 (16.2％) ETEC,16(10.8％) EIEC and 2(1.4％) EHEC.The median ages of diarrheal children with DEC infections were 14 months (range:3 months to 13 years) and 62.8％ of them were ＜2 years.Among 125 DEC isolates tested for antimicrobial susceptibility,the rates of resistance to ampicillin,trimethoprim-sulfamethoxazole,cefotaxime,cefepime,gentamicin,ceftazidime,amoxicillinclavulanate,ciprofloxacin,and ofloxacin in a descending order were 55.2％,35.2％,28.0％,27.2％,23.2％,8.8％,5.6％,4.0％ and 4.0％,respectively.Resistance rates of EIEC to cefotaxime,cefepime and ceftazidime were 50.0％,43.8％ and 25.0％,respectively,which were higher than those of EPEC,ETEC and EHEC.Conclusion DEC is the important enteric bacteria that causes bacterial diarrhea in children in this study.

Objective To investigate the risk factors for lower extremity peripheral arterial disease (LEPAD) in elderly patients with Type 2 diabetes mellitus(T2DM).Methods To detect ankle brachial index (ABI) of 356 elderly patients with T2DM,and analyze whether risk factors had correlation with ABI.Results We found that age,systolic blood pressure,HbAlc,2-hours post-prandial (2hpp) plasma glucose had inverse correlation,yet 2hpp C-peptide plasma level,2-hpp insulin level had positive correlation with ABI by bivariate correlation test.Conclusions Age,systolic blood pressure,2hpp plasma glucose,2hpp C-peptide plasma level,2hpp insulin level were related with lower extremity arterial disease in the elderly with T2DM,among which age was the most important risk factor for LEPAD.

ObjectiveTo investigate the complications after intracranial neurosurgery in the postanesthesia care unit (PACU). Methods2166 patients enrolled into PACU after intracranial neurosurgery were reviewed. ResultsAmong the complications, the most frequent ones were hypertension (14.0%), arrhythmia (13.9%), pain (13.7%), shivering (10.5%), nausea and vomiting (9.3%), and delirium (8.6%). The least ones were hypoxemia (3.4%), respiratory obstruction (1.9%), delayed recovery (1.5%), and hypotention (0.5%). Abnormal temperature and residual block occurred at 7.2% and 22.8% in the patients who were monitored. All complications were treated immediately, and all the patients transferred to neurosurgical ward with modified Aldrete score over 9～10. ConclusionThe patient in PACU need well management to insure safe and smooth recovery from anesthesia after intracranial surgery.

Objective To retrospectively analyze the role of 3-dimensioual conformal radiotherapy (3-DCRT) after percutaneous transhepatic portal vein stenting and transcatheter arterial chemoembolization (PTPVS-TACE) in the treatment of patients with hepatocellular carcinoma (HCC) complicated by main portal vein tumor throw.bus (MPVTT).Methods Between July 2002 and July 2007,45 patients with HCC complicated by MPVTT were treated by PTPVS-TACE.Among them,3-DCRT were undertaken for MPVTT in 16 patients (group A),the other 29 patients were not treated with 3-DCRT(group B).The clinical effects,complication,stent patency rates,cumulative survival rates were evaluated among groups.The Kaplan-Meier method and log-rank test were used for survival analysis.Results No patient died during stent placement or within the preceding first 24 hours.No severe procedure-related complications were observed.The 60--,180--,360--day cumulative stent patency rates were 100.0%,62.2% and 34.6% in group A,and 58.6%,21.7% and 10.8% in group B,respectively,showing significant difference between the two groups (X2 =9.672,P <0.01).The mean patency time was(475±137) and (200±61)days,respectively.The 60--,180--,and 360--day cumulative survival rates were 93.8%,81.3% and 32.5% for group A,86.2%,13.8% and 6.9% for group B,respectively.There were significant statistical differences between the two groups(X2=9.672,14.596,P < 0.01).Conclusion Treatment with PTPVS-TACE-3-DCRT is a more effective modality than PTPVS-TACE for HCC complicated by MPVTT.

OBJECTIVE:To study the effect of Runchangtongbian mixture (an agent of loosing bowel to relive constipation) on bowel propulsion in mice. METHODS:The coom propulsion percentages in bowel in Runchangtongbian mixture group, model group (treated with bowel propulsion suppressants) and blank group were computed and compared, and the data were analyzed statistically. RESULTS:As compared with the blank group, bowel propulsion was greatly enhanced in Runchangtongbian mixture group(P